What is the treatment for foot drop?
The most common treatment is an ankle-foot orthosis (AFO) which provides support to the ankle and foot. The AFO helps control foot drop and ankle instability by providing a better sense of balance. Often times, individuals are fit with a custom molded plastic AFO, however, there are other orthotic options available that provide superior function and performance.
The goal of orthotic treatment options is to help you maximize your mobility and independence. Chances are your most important need is to be able to walk better, without assistance and for longer periods of time without getting exhausted. Hundreds of thousands of people with foot drop have experienced a mobility rebirth thanks to the stability and dynamic assistance provided when wearing ToeOFF®, a unique patented carbon fiber composite AFO.
What is ToeOFF and how does it work?
The ToeOFF product line is made of ultra-light weight materials including carbon fiber, fiberglass and Kevlar®. The light weight is especially important to those individuals affected with neuro-muscular deficits from CMT. ToeOFF provides a natural biomechanical response similar to the movement of your own muscles. The footplate and “open heel” design are major contributors to the function of the ToeOFF. When your heel strikes the ground, energy passes down the side of the AFO to create a dynamic response that reflects the energy to the footplate to prevent “foot slap” and lift up the forefoot, much like the spring of a swimming pool diving board. The design and materials allow for enough strength to control the position of your foot as you swing your leg, making walking easier with less energy consumption. Unlike a custom molded plastic AFO that covers and immobilizes the ankle, the ToeOFFs open heel design allows your heel to move freely as it normally would, allowing proper biomechanics to occur in the foot.
What are the benefits of ToeOFF?
ToeOFF provides a stable, fluid, propulsive and symmetrical walking pattern. ToeOFF can improve your quality of life by:
Restoring balance and improving stamina – ToeOFFs strong and durable design allows you to move on uneven surfaces and climb stairs or ramps more confidently and independently, without stumbling or falling. Studies have shown that ToeOFF users can walk further in ToeOFF than in conventional molded plastic AFOs.
Decreasing risk of muscle atrophy – A recent study revealed that plastic AFOs can lead to ankle immobilization which resulted in calf muscle atrophy.
Fits well into good support shoes without having to increase shoe size – The thin and lightweight carbon fiber design ensures that you can wear your AFO inside any standard shoe that provides good support – without increasing your shoe size!
Providing function with fashion – Ask your orthotist about our Fantasy line that offers ToeOFF in ivory, purple, black or dark blue, or the removable SoftSHELL covers that are offered in beige or dark brown.
How do I obtain a ToeOFF?
ToeOFF Products require a prescription from your physician and must be fit by a certified orthotist who will go through an eight-step customization process. The ToeOFF product line offers a variety of AFOs with graded stability to accommodate for different individual’s needs, sizes, and stabilizing properties. While the ToeOFF products are state-of-the-art in both materials and design, not every individual may be a candidate for ToeOFF. Allard USA offers a 30 day “Try It – You’ll Like It” Patient Satisfaction Guarantee for you to “test” that the ToeOFF will work for you. Talk to your physician about specifying “Allard ToeOFF – no substitutions” on the prescription and specifically ask for Allard ToeOFF with your Orthotist – this will ensure that you are offered the unique patented design of the ToeOFF. ToeOFF products are covered by Medicare and most insurance companies.
Your First Step toward independence
Finding the most appropriate AFO can be challenging so we encourage you to discuss your orthotic treatment goals and options with your physician, physical therapist, and orthotist. Taking an active role in your treatment plan will ensure that you receive the most beneficial and appropriate AFO that addresses your specific needs. There are many AFO choices that you will encounter – knowing your options and understanding the differences will ensure that you achieve the maximum success from your orthotic solution.
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Case Study: Maximizing Functional Outcomes Utilizing Objective Gait Analysis
Vincent DeCataldo, BOCPO, NJ LPO
Manager Allard O&P Partnership, Allard USA
Identifying maximal functional outcomes is often limited to visual gait analysis and subjective patient commentary, making it difficult to know if an adjustment or change of design has made a difference to function. Utilizing a portable gait analysis system, we are able to use quantified measures of gait to modify our components, designs, and gait training to maximize functional outcomes.
Subject is a 39 year old female with CMT and prominent symptoms of bilateral paresthesia and weakness in hands and feet. Patient was initially fit with bilateral custom posterior leaf spring (plastic) AFOs approximately 7 years ago. She rejected the plastic AFOs because they caused sores on her feet and she felt that it took more effort to walk with the orthoses than it did without. One year ago, she started wearing the Allard ToeOFF® and felt that they assisted her with activities involving long distances. She also tried the Allard BlueROCKER® and Allard Ypsilon™. Currently she walks, runs, trail hikes, and practices yoga on a regular basis and changes her Allard AFOs to give her more or less support and propulsion based on her activity.
Subject was tested in three different bilateral conditions. The custom fit dynamic carbon composite AFO designs included: 1) without customization, 2) with increased rigidity without customization, and 3) same rigidity as condition 2 but with customization to accommodate the heel height of the shoe. Temporal-spatial and pelvic motion data was collected utilizing a BTS G-Walk Portable Gait Analysis system.
Results and Discussion
Utilizing the G-Walk system, functional outcomes due to changes in orthotic design and customization can be measured and documented. The orthotic intervention that provided the maximum function for this patient happened to be the more rigid design (Allard BlueROCKER) customized for shoe heel height which allowed for increased speed and decreased pelvic motion. Speed and percent of double limb support were closest to normal values for women.
Acknowledgements: Thank you to Virginia Mamone and Brittany Stryker, OTD, OTR/L, BOCO and Orthopedic Motion
– Susan Ruediger, CMTA Director of Development, foot drop as a result of CMT.
– Virginia Mamone, foot drop as a result of CMT.
References to provide to your Physician, Physical Therapist and Orthotist
1 Ramdharry, G., Pollard, A., Marsden, J., Reilly, M., Comparing Gait Performance of People with Charcot-Marie-Tooth Disease Who Do and Do Not Wear Ankle Foot Orthoses. MRL Center for Physiotherapy Research International, 17(4), pp 191-199. 2012.
2 Dufek, J., Neumann, E., Hawkins, C., and Otoole, B., Charcot-Marie-Tooth AFO Mechanics and Gait Patterns. Lower Extremity Review. 2014.